Provider Demographics
NPI:1144598160
Name:PHYSICAL MEDICINE OF COLORADO, PLLC
Entity Type:Organization
Organization Name:PHYSICAL MEDICINE OF COLORADO, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:TERRY
Authorized Official - Suffix:
Authorized Official - Credentials:D,O
Authorized Official - Phone:303-912-3596
Mailing Address - Street 1:3083 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-2509
Mailing Address - Country:US
Mailing Address - Phone:303-440-0500
Mailing Address - Fax:303-440-4621
Practice Address - Street 1:3083 WALNUT ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-2509
Practice Address - Country:US
Practice Address - Phone:303-440-0500
Practice Address - Fax:303-440-4621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR-1561111N00000X
CO17008208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty